Panic and sadness - a cut out and keep guide

For the unaffected who would like to understand

I’ve been thinking a lot about how I write about mental illness recently. Is what I say too repetitive, too self centred, too whiny? Am I mentally ill enough to wang on about it all the time? Does the huge amount of luck I’ve received in other areas of my life make the complaints I have about my brain seem trivial? Nothing pisses me off more than seeing people talk about anxiety or OCD in a way that a) seems to make it clear that they don’t actually suffer from these illnesses and b) suggests they might well be utilising mental illness to curry engagement. But am I also guilty of this in some way, using mental illness as an identity I can parlay into work or opportunity (I wrote a whole book about it so I guess the answer is obvious here)? And lastly, am I actually helping anyone else when I write about mental illness? On that, I think the answer is, on balance, yes. It helps me an enormous amount when other people talk openly about the hardest parts of living with mental illness, and as long as this openness isn’t accompanied by exhortations to buy crystals or do liver detoxes, I think all (genuine) conversation about mental health is worthwhile. But it seems to me that I’m usually addressing those who’ve experienced some form of illness themselves. And while I still think that’s the most effective way I can use my voice, it sometimes means neglecting readers who don’t suffer themselves but definitely have loved ones who do. The reason I write so much about my own brain is in an attempt to make others feel less alone, and to make myself feel less alone too. But that only goes so far. In order to really eradicate that feeling of isolation (and get rid of the despair which comes with it), people who have no experience of mental illness have to be included in the discussion. So this is for the mentally healthy readers (I am in awe of your lovely brains), here is my attempt at a cut out and keep rough explanation of four crummy but common mental health problems someone you know might be experiencing.

A panic attack

You are driving to your friend's house during a storm. To get there, you have to cross a very busy road. The weather is atrocious, rain coming down in angled sheets, thunder echoing between the buildings and lightning illuminating the enormous body of water which has suddenly flooded the road. As the cars inch across, you realised your peripheral vision is receding. Black spots begin to flood your remaining sight and you think you must be dying. Then the loudest roar you’ve ever heard seems to come from inside your ears. Your heart starts hammering inside your chest, as if desperate to escape the situation (and go where? You are in the middle of a road). Then the breathing stuff begins. It’s such a strange quirk of the body to make you feel as though you absolutely cannot breathe when you most definitely can. It’s the most horrifying sensation - your throat is closing up, it feels like you’re sucking on a blocked straw. A panic attack prompts your brain to send signals to your body that you’re in mortal peril (even if you’re just trying to cross a road). In response, your body releases massive dollops of adrenaline so you’re shaking like a leaf. All you can think is, “I want to get out, I need to get out.” By now your entire body is in meltdown. You are sure you’re dying, but you cannot get out of the car or call for help. You take ragged breaths and put your hand to your chest. The skin is soaked through with cold sweat. You make it across the road eventually, your whole body shaking uncontrollably, and you will be so wiped that you’ll have to sleep for the rest of the day. You begin to think something is seriously wrong with your heart, because why else would you feel that ill so fast? You will not cross that road again for a decade. You still cannot drive on motorways on your own as a result. Annoyingly this avoidance tactic merely reinforces the fear.

In films, panic attacks are almost cartoonish - a person pounds their chest and gasps theatrically - but in reality you’ll probably never know when someone is in the middle of one. The person having a panic attack is certain that they must look insane, but usually at most they might appear slightly distracted. It’s quite hard to reason with someone who’s in the middle of a panic attack. You tell them to breathe and they look at you like you’re nuts. They can’t, don’t you see?! They are in mortal peril (they are not but that doesn’t register in the moment) and you are not taking it seriously enough (you are, but they are insane right now). Best to show them, breathe with them, sit down and tell them they’re safe. Give them space, give them water, distract with a joke. Panic attacks suck arse.

Depression

This one is harder for me to describe since I’ve only ever been depressed because I’ve been anxious. In other words, it was a secondary diagnosis caused by the distress of intrusive thoughts and endless worry. Luckily, I haven’t had a bad bout of it since my twenties. If I had depression too, I’d be a triple threat (anxiety, OCD, depression, the unholy trifecta) but only to myself. This is how it felt.

First the physical, because sometimes it is easier to understand something as varied and slippery as depression through what it does to you physically. The colour of everything changes all of a sudden, I remember that most of all. It’s as if someone has applied an early Instagram filter to the world, making it appear slightly too bright and far too raw. You can only describe it as sinister really. Neon lights make you feel like you’re watching the world from behind glass. Things slow down somehow, movement is awkward and forced, it feels as though you are wading through treacle with every step you take. A feeling of fatigue crashes over you, and all you want to do is lie down and sleep for as long as physically possible. When you are awake, you spend a lot of time staring at walls. You cry a lot too. You don’t eat (apart from Weetabix when your best mate insists you must have something). You sleep in your parents bed for a few nights, despite being a fully grown adult. Every single piece of information you come across in the outside world is another sign that our very existence is hopeless. Every private thought you have tells you that you are also hopeless. Depression is a black hole which will demand every single crumb of joy and then come back for more. In an attempt to cheer you up, your mum takes you shoe shopping and you sob as she pays for a pair she thinks you like. It is a desperately kind and completely useless gesture. It make you feel worse because you can tell that the shoes are indeed the kind you’d have liked before the strange filter and the hopeless treacle wading, but you are completely certain that you will never find the capacity to enjoy them again.

I don’t believe you should rate or compare mental illness (just as you wouldn’t with say diabetes and asthma) but I do think my brief encounters with depression have been the most disturbing. Anxiety and OCD are sometimes a matter of caring about things too much. Small irrelevant issues, blown up to loom large over your head and threatening to explode. But depression made me care about nothing at all. One day I realised I didn’t care about living. That was new and dangerous. And that was what prompted me to finally take medication. I’ll say this for big pharma, they might be as cynical and money grabbing as everyone says but at least they made me like my life again. All the shoes in the world couldn’t do that. If you suspect someone you love is falling into that black hole, talk to them. Don’t wait for it to swallow them up.

OCD

I’ve written about OCD at length here and elsewhere and it’s an incredibly complex and varied illness which I don’t have room to fully delve into. Instead I’ll give you one example of an obsession which might help you to understand the thought process a bit better.

You are hanging out with a new friend one day, when a thought pops into your head. “What if she can hear my thoughts?” An intrusive thought, we all have tonnes of them every day but sometimes with OCD they stick. This one sticks. You are immediately very worried by this idea, perturbed by the slightest possibility that your new friend can hear your thoughts. You are also worried about why you’ve even had such a strange thought. You mentally reply to the thought, telling it to go away, that it isn’t true, but this only provokes more ‘what if’ thoughts. What if she can hear these thoughts? What if she knows you know? You look over at your mate, trying to assess whether or not this is true by the look on her face and realise too late that you’ve fallen into the trap set by OCD. You are engaging with the thoughts. You are taking them seriously and fuelling the fire.

Once she’s gone home, you spend hours interrogating the initial idea, going over and over different iterations of it and becoming more and more bogged down. OCD is a very strange thing, in that you know that these thoughts aren’t real but you feel like they might be. You cannot rest until you have 100 percent certainty one way or another (something you will never have in life about anything). For some people, these terrifying thoughts impel them to perform rituals to effectively neutralise the threat in some way. That’s where you see the hand-washing, the need for symmetry, the habits which make no sense to other people (turning a light switch on and off a certain number of times, for example). You are increasingly distressed by how much this one ridiculous thought is consuming your time. You no longer find the thought silly, you have no power to push it away or think about anything else. You are exhausted but your brain will not stop. The thoughts can run for hours and hours on end, your mind coming up with worse and worse scenarios you must analyse and engage with. You only stop when your brain comes up with a new obsession and the cycle starts all over again.

OCD is incredibly distressing. It’s also ridiculous a lot of the time (and often embarrassing), which is why people don’t talk openly about their OCD thoughts. I’ll never forget the day my mum (a very mentally healthy woman who’s never struggled with OCD) told me a distressing intrusive thought she’d once had. It made me feel less crazy. If someone is struggling with intrusive thoughts, climb down into the pit with them.

Anxiety

Not just worry. Not understandable, situational angst but mushroom clouds of fear which are entirely disproportionate and most often completely made up. It’s living in a lighthouse where the search beam is always sweeping the ocean for boats about to crash into rocks. You’re always on red alert, living in fight or flight, crouched for catastrophe. Anxiety makes living in the moment impossible. Your head is always in the future, assessing every possible scenario for threats. And once you’re a veteran, you can assess both short and long term (realistic and ridiculous) threats at the same time!

You wake up with a rapid heartbeat and a tension headache. Your hands are clenched into balls, you are already ready for whatever emergency is sure to come your way. As you get ready for the day, there is a feeling of dread rapidly pooling somewhere below your sternum. The adrenaline is going nuts everywhere else in your body. Your stomach hurts. You walk to work and imagine every building collapsing on top of your head in vivid detail. You see a cyclist whiz past you and flinch, expecting a catastrophic impact. At work you are certain everyone must hate you, that you’re terrible at your job, that there will be a fire and you won’t be able to escape. You are distracted, your body so ready for battle that you are unable to think clearly or talk normally. You force yourself to sit in your chair and not run away. You are jittery and tired, assessing every situation for danger and unable to stop. When you go home, it’s worse because your brain now has free rein to catastrophise without the added pressure of work. You go to bed but you have totted up endless worries throughout the day and your brain will not stop whirring as it processes them all. You wake up at 3am thinking about death. The cycle continues the next day.

Anxiety rejects spontaneity, whimsy and refuses to allow you the joy which is found when you cede control. I gave up drinking after 9/11 because I had to be the designated driver on nights out. In my head, I was the only person standing between my friends and a certain terror attack. They were more likely to be injured by my driving but that would imply the worry was rational, and it was not. It rarely ever is. Sometimes the best thing you can do with a person who is stuck in a loop of anxiety is to distract their brains for a bit. In doing that, you can break the cycle. A break in the cycle is a beautiful moment of relief, where the clouds part and you suddenly see the world for what it is, rather than the terrifying version your brain is giving you.

I hope this is helpful in some way. If you suffer with mental illness, what would you like other people to know about it? What would you tell loved ones who want to understand you better?